High Prevalence of Subclinical Left Ventricular Dysfunction in Patients with Psoriatic Arthritis

• Published in: Journal of rheumatology 2011-07, Vol.38 (7), p.1363-1370
• Main Authors: QING SHANG, TAM, Lai-Shan, WAI-KWOK YIP, Gabriel, SANDERSON, John E, QING ZHANG, KWOK-MING LI, Edmund, YU, Cheuk-Man
• Format: Article
• Language: English
• Subjects: Adult; Arthritis, Psoriatic - complications; Arthritis, Psoriatic - physiopathology; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular system; Case-Control Studies; China; Cross-Sectional Studies; Diastole - physiology; Diseases of the osteoarticular system; Echocardiography; Female; Heart; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Hyperlipidemias - epidemiology; Hyperlipidemias - physiopathology; Hypertension - epidemiology; Hypertension - physiopathology; Inflammatory joint diseases; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Prevalence; Risk Factors; Systole - physiology; Ultrasonic investigative techniques; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - epidemiology; Ventricular Dysfunction, Left - physiopathology
• ISSN: 0315-162X; 1499-2752
• DOI: 10.3899/jrheum.101136

Endothelial dysfunction and early atherosclerosis have been found in patients with psoriatic arthritis (PsA) without cardiovascular disease (CVD) risk factors. Few studies have investigated whether there is any early impairment of myocardial function. The aims of our study were to determine the prevalence of subclinical left ventricular (LV) dysfunction in PsA patients and the disease-related risk factors. Ninety-four PsA patients without clinical evidence of CVD and 63 healthy subjects were enrolled. All underwent conventional echocardiography and tissue Doppler imaging. Sixty-one (65%) patients with PsA had evidence of subclinical LV dysfunction as defined by mean myocardial peak systolic velocity (Sm) of basal 6 segments < 4.4 cm/s, lateral E' < 11.5 cm/s, and/or lateral E/E' > 10. Thirty-six (38%) patients had only diastolic dysfunction, 4 (4%) had only systolic dysfunction, and 21 (22%) had both systolic and diastolic dysfunction. PsA patients with subclinical LV dysfunction were older, had a higher age at diagnosis of PsA and of psoriasis, a longer disease duration, a higher prevalence of hypertension and hyperlipidemia, higher levels of serum creatinine, and more antihypertensive treatment than those with normal LV function. Multivariate regression showed that age at diagnosis of PsA > 40 years (OR 3.388, 95% CI 1.065-10.777, p = 0.039) and hypertension (OR 4.732, 95% CI 1.345-16.639, p = 0.015) were independent predictors of subclinical LV dysfunction. PsA patients without established CVD disease and in the absence of traditional CV risk factors have a high prevalence of subclinical LV dysfunction.